A Cost-Effectiveness Analysis of Rooming-in and Breastfeeding in Neonatal Opioid Withdrawal.

OBJECTIVE: Our cost-effectiveness analysis investigated rooming-in versus not rooming-in to determine optimal management of neonates with neonatal opioid withdrawal (NOW). STUDY DESIGN: A decision-analytic model was constructed using TreeAge to compare rooming-in versus not rooming-in in a theoretical cohort of 23,200 newborns, the estimated annual number affected by NOW in the United States. Additional considerations included the effect of breast milk versus formula milk in evaluating the need for pharmacotherapy. Primary outcomes were needed for pharmacotherapy and neurodevelopment. We assumed a societal perspective in evaluating costs and maternal-neonatal quality-adjusted life years (QALYs) using a willingness-to-pay threshold of $100,000/QALY. Model inputs were derived from literature and varied in sensitivity analyses. RESULTS: Rooming-in resulted in fewer neonates requiring pharmacotherapy when compared with not rooming-in. The rooming-in group had more neonates with intact/mild neurodevelopmental impairment and fewer cases of moderate to severe impairment. Rooming-in resulted in cost savings of $509,652,728 and 12,333 additional QALYs per annual cohort. When the risk ratio of need for pharmacotherapy in rooming-in was varied across a clinically plausible range, rooming-in remained the cost-effective strategy. CONCLUSION: Maternal rooming-in with newborns affected by NOW leads to reduced costs and increased effectiveness. Management strategies should optimize nonpharmacological interventions as first-line treatment.

Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian Unified National Health System. / Análise de custos da atenção hospitalar ao parto vaginal e à cesariana eletiva para gestantes de risco habitual no Sistema Único de Saúde.

This study estimated the costs of vaginal delivery and elective cesarean section without clinical indication, for usual risk pregnant women from the perspective of the Brazilian Unified Health System. Data was collected from three public maternity hospitals located in the southeast region of Brazil through visits and interviews with professionals. The cost components were human resources, hospital supplies, capital cost and overhead, which were identified, quantified and valued through the micro-costing method. The costs with vaginal delivery, elective cesarean section and daily hospital charge in rooming for the three maternity hospitals were identified. The mean cost of a vaginal delivery procedure was R$ 808.16 and ranged from R$ 585.74 to R$ 916.14 between hospitals. The mean cost of elective cesarean section was R$ 1,113.70, ranging from R$ 652.69 to R$ 1,516.02. The main cost component was human resources for both procedures. When stay in rooming was included, the mean costs of vaginal delivery and cesarean were R$ 1,397.91 (R$ 1,287.50 - R$ 1,437.87) and R$ 1,843.87 (R$ 1,521.54 - R$ 2,161.98), respectively. Cost analyses of perinatal care contribute to the management of health services and are essential for cost-effectiveness analysis.

Esse estudo estimou os custos do parto vaginal e da cesariana eletiva, sem indicação clínica, para gestantes de risco habitual na perspectiva do Sistema Único de Saúde provedor. A coleta de dados incluiu três maternidades públicas situadas na região Sudeste, nas quais foram realizadas visitas e entrevistas com os profissionais. Os itens de custos incluídos foram recursos humanos, insumos hospitalares, custo de capital e administrativos, que foram identificados, quantificados e valorados pelo método de microcusteio. Foram identificados custos com o parto vaginal, cesariana eletiva e diária em alojamento conjunto para as três maternidades. A média do custo do procedimento parto vaginal foi de R$ 808,16 e variou de R$ 585,74 a R$ 916,14 entre as maternidades. O custo médio da cesariana eletiva foi de R$ 1.113,70 com variação de R$ 652,69 a R$ 1.516,02. O principal item de custo foi os recursos humanos em ambos os procedimentos. Com a inclusão do período de permanência em alojamento conjunto, o custo médio do parto vaginal foi de R$ 1.397,91 (R$ 1.287,50 - R$ 1.437,87) e da cesariana R$ 1.843,8791 (R$ 1.521,54 - R$ 2.161,98), este 32% superior ao primeiro. As análises de custo na atenção perinatal contribuem para a gestão dos serviços de saúde, além de serem essenciais para análises de custo-efetividade.

Rooming-In to Treat Neonatal Abstinence Syndrome: Improved Family-Centered Care at Lower Cost.

BACKGROUND AND OBJECTIVE: The incidence and associated costs of neonatal abstinence syndrome (NAS) have recently risen sharply; newborns with NAS occupy 4% of NICU beds. We implemented a coordinated program for NAS including standardized protocols for scoring, medications and weaning, and a calm rooming-in environment, to improve family-centered care and to decrease both length of stay (LOS) and hospital costs. METHODS: In early 2013, a multidisciplinary quality improvement team began consecutive plan-do-study-act (PDSA) cycles. We trained nurses in modified Finnegan scoring, ensured scoring only after on-demand feeds during skin-to-skin care, and standardized physician score interpretation. We provided prenatal family education, increased family involvement in symptom monitoring and nonpharmacologic treatment, and treated otherwise healthy infants on the inpatient pediatric unit instead of in the NICU. We measured outcomes using statistical process control methods. RESULTS: At baseline, 46% of inborn infants at-risk for NAS were treated with morphine; by 2015, this decreased to 27%. Adjunctive use of phenobarbital decreased from 13% to 2% in the same period. Average LOS for morphine-treated newborns decreased from 16.9 to 12.3 days, average hospital costs per treated infant decreased from $19 737 to $8755, and costs per at-risk infant dropped from $11 000 to $5300. Cumulative morphine dose decreased from 13.7 to 6.6 mg per treated newborn. There were no adverse events, and 30-day readmission rates remained stable. CONCLUSIONS: A coordinated, standardized NAS program safely reduced pharmacologic therapy, LOS, and hospital costs. Rooming-in with family and decreased use of NICU beds were central to achieved outcomes.

Análise de custos da atenção hospitalar ao parto vaginal e à cesariana eletiva para gestantes de risco habitual no Sistema Único de Saúde / Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian Unified National Health System

Resumo Esse estudo estimou os custos do parto vaginal e da cesariana eletiva, sem indicação clínica, para gestantes de risco habitual na perspectiva do Sistema Único de Saúde provedor. A coleta de dados incluiu três maternidades públicas situadas na região Sudeste, nas quais foram realizadas visitas e entrevistas com os profissionais. Os itens de custos incluídos foram recursos humanos, insumos hospitalares, custo de capital e administrativos, que foram identificados, quantificados e valorados pelo método de microcusteio. Foram identificados custos com o parto vaginal, cesariana eletiva e diária em alojamento conjunto para as três maternidades. A média do custo do procedimento parto vaginal foi de R$ 808,16 e variou de R$ 585,74 a R$ 916,14 entre as maternidades. O custo médio da cesariana eletiva foi de R$ 1.113,70 com variação de R$ 652,69 a R$ 1.516,02. O principal item de custo foi os recursos humanos em ambos os procedimentos. Com a inclusão do período de permanência em alojamento conjunto, o custo médio do parto vaginal foi de R$ 1.397,91 (R$ 1.287,50 - R$ 1.437,87) e da cesariana R$ 1.843,8791 (R$ 1.521,54 - R$ 2.161,98), este 32% superior ao primeiro. As análises de custo na atenção perinatal contribuem para a gestão dos serviços de saúde, além de serem essenciais para análises de custo-efetividade.

Abstract This study estimated the costs of vaginal delivery and elective cesarean section without clinical indication, for usual risk pregnant women from the perspective of the Brazilian Unified Health System. Data was collected from three public maternity hospitals located in the southeast region of Brazil through visits and interviews with professionals. The cost components were human resources, hospital supplies, capital cost and overhead, which were identified, quantified and valued through the micro-costing method. The costs with vaginal delivery, elective cesarean section and daily hospital charge in rooming for the three maternity hospitals were identified. The mean cost of a vaginal delivery procedure was R$ 808.16 and ranged from R$ 585.74 to R$ 916.14 between hospitals. The mean cost of elective cesarean section was R$ 1,113.70, ranging from R$ 652.69 to R$ 1,516.02. The main cost component was human resources for both procedures. When stay in rooming was included, the mean costs of vaginal delivery and cesarean were R$ 1,397.91 (R$ 1,287.50 - R$ 1,437.87) and R$ 1,843.87 (R$ 1,521.54 - R$ 2,161.98), respectively. Cost analyses of perinatal care contribute to the management of health services and are essential for cost-effectiveness analysis.

[Partial "rooming-in"--a model from the I department of gynecology and obstetrics, university of Vienna (author's transl)]. / Das partielle rooming-in. Modell der I. Universitäts-Frauenklinik Wien.

A model of a modified "rooming-in" is presented, which enables a longer and more intensive contact between mother and child. Mobile transport-baskets as used also for example in supermarkets etc. enabled us to perform this system of a partial "rooming-in" without any architectural modifications in our clinic and therefore with very low costs. In spite of all these limitations the effect of this "rooming-in" is sufficient. We proved this statement by an inquiry which showed the result, that partial "rooming-in" is preferred a total "rooming-in" by about 75% of our maternity patients.